emergency public health & disaster medicine

Emergency Public Healthand

Disaster MedicineBobby Kapur, M.D., M.P.H.

Associate Professor of Medicine & PediatricsAssociate Chief for Academic Affairs

Section of Emergency Medicine

Emergency Public Health 2

1. Present the scope & impact of Public Health Emergencies

2. Define the concept of Emergency Public Health3. Differentiate Emergency Public Health from

Disaster Medicine4. Show how Emergency Public Health can lead to

Public Health Security

Objectives


Public Health Emergencies

Scope of Problem

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Natural Public Health Emergencies

Sichuan EarthquakeMay 19, 2008


Industrial Public Health Emergencies

BP Gulf of Mexico Explosion

April 20, 2010


Infectious Disease Public Health Emergencies


Terrorism Public Health Emergencies

9/11/2001


Increasing Threats to Cities

Number of Declared US Disasters 1988-2008

(Source: Data from FEMA http://www.fema.gov/news/disaster_totals_annual.fema)

http://www.fema.gov/news/disaster_totals_annual.fema


Increasing Densities of Cities

Current and Projected Percentage of Global Population Living in Urban Areas

(Source: Data from UN. http://esa.un.org/unup/index.asp?panel=1)

http://esa.un.org/unup/index.asp?panel=1


Emergency Public Health

New & Emerging Field


Emergency Public Health: A New Concept

• New field of academic study• “Public Health” approach to large-scale

emergencies and crises• Population-based analysis


Emergency Public Health vs. Disaster Medicine

“Hazards”: events that cause Emergencies – Natural (earthquakes, hurricanes, droughts)– Deliberate (bombing, chemical attack,

biological attack)– Accidental (nuclear plant malfunction)

“Disaster”: event that overcomes local resources

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Disasters: Causes?


Disaster Cycle

Hazard



Emergency Public Health differs from Disaster Medicine because it encompasses more than

just the management of specific hazards.


Emergency Public Health and the Disaster Cycle

Hazard

Epidemiology

Rapid NeedsAssessment

Surveillance & Monitoring



Hazard

Patients

Govt:EMSFire

Police Hosps

Private Sector

NGOs

Public Health LawTechnology

EpidemiologyRapid Needs AssessmentsSurveillanceMonitoring

DisasterMedicine

EmergencyPublic Health

AcadCenters


Multiple components of society will be disrupted by public health emergencies:

– Physical and Mental Health– Security– Housing– Food and Water

Long period of rehabilitation

Emergency Public Health: Broad Impact


Large-scale crises will affect all sectors:– Government– Private sector– Non-governmental Organizations (NGOs), – Civilians

Each sector will provide and utilize resources during a crisis

Emergency Public Health: Multiple Sectors



Public Health Security


Public Health Security Framework


Resilience: a population’s capacity to withstand adversity and to recover quickly

Cities will achieve greater levels of protection from collapse by increasing:

– Systemized surveillance– Assessments– Coordination– Communication

Emergency Public Health: Resilience


Resilience Analysis Model



Government & Public Health Emergencies


National Government

Institute of Medicine (IOM) states there are 6 major roles of the government in public health: 1.Policy 2.Finance3.Public health protection4.Information gathering and dissemination5.Capacity building6.Direct patient health care services


National Response Framework


Key Components of Mutual Aid Agreements

Interoperabilityof Communications

Credentialing of

Responders

Financial Responsibilities

Procedures for Requesting

Resources and Personnel

Command and Control of Personnel

and ResourcesLiability

(Source: Data from Department of Homeland Security. National Response Framework. Washington, DC 2008. Available at http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.)

http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.%20Accessed%20February%202010


Public Health Law



Non-Government Sector

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Public-Private Partnerships (PPPs): Incentives

1. Growing sense of corporate social responsibility, which includes staff motivation

2. Benefits of “positive branding” 3. Business intelligence 4. Pure willingness to do good


Code of Conduct for NGOs in Public Health Emergencies

First priority is the Humanitarian imperative (the right to receive humanitarian assistance, unimpeded access to affected populations).Aid is given regardless of race, creed or nationality and is prioritized based on need alone.Aid will not be used as a tool to support a particular political or religious standpoint.NGOs will act independent of governments and not act as instruments of government foreign policy.Culture, structures and customs of communities and countries will be respected.Emergency public health response will attempt to strengthen local capacities (staff, materials, companies, local NGOs), when possible.Intended beneficiaries should be involved in the design, management and implementation of assistance programs, when possible.Relief efforts should not only meet basic needs but should strive to reduce future vulnerabilities to public health emergencies (mitigation).NGOs will be accountable to their partners, both the populations who need assistance and the donors who wish to assist, in a responsible and transparent manner.NGOs will recognize victims as dignified people and not hopeless individuals in their organization’s information, publicity and advertising activities.



Public Health Tools


• Epidemiological Studies• Rapid Needs Assessments• Surveillance & Monitoring• Evaluation Processes

Emergency Public Health: Public Health Tools


Epidemiology in Public Health Emergencies


Role of Epidemiological Studies in Public Health Emergencies

Epidemiological Studies Data Collected Limitations

Case series: sequence of case reports with common elements such as similar clinical features and suspected common exposures

Clinical features Specialized treatment of specific

types of injuries

Lack of generalizations Non-reporting of less severe

injuries treated outside the hospital setting

Cross sectional: study of several individuals at one point in time about information on health status, health-related behaviors, and other exposure factors

Frequencies of mortality and morbidity

Behaviors during and after emergencies

Diversity of outcomes experienced during the event

Absence of population counts Poor sampling methods leading

to non-representative samples Bias from selective survival,

population movement, and recall

Case control: study of individuals in whom a disease has already occurred in order to find out whether these individuals have been exposed to a particular risk factor

Risk factors

Bias due to selection of cases and controls

Cohort study: study of a group exposed to a particular factor and another group not exposed to this factor is followed up over time to determine occurrence of disease

Estimate incidence and magnitude of risk

Short and long-term and direct and indirect health effects

Emergency-related outcomes

Identification of a defined cohort Logistics of long-term data

collection Loss to follow up


Rapid Needs Assessments: Cluster Sampling


Feedback Mechanisms

•Surveillance•Monitoring•Evaluation

Professionalization of responding and managing public health emergencies.


WHO Framework for Surveillance


Conclusions

1. Public Health Emergencies are broad-scale events that impact many areas and have long periods of recovery and rehabilitation

2. Public Health Security depends on a region’s Resilience

3. Public Health Tools can help manage these emergencies and guide decision-making

emergency public health & disaster medicine

Health & Medicine